1
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Machado FP, Vicari AR, Bauer AC. Assessing the impact of positive cultures in preservation fluid on renal transplant outcomes: a scoping review. J Nephrol 2024:10.1007/s40620-024-01972-1. [PMID: 38869823 DOI: 10.1007/s40620-024-01972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/26/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Infection following kidney transplantation is a significant risk factor for adverse outcomes. While the donor may be a source of infection, microbiological assessment of the preservation fluid (PF) can mitigate potential recipient contamination and help curb unnecessary antibiotic use. This scoping review aimed to describe the available literature on the association between culture-positive preservation fluid, its clinically relevant outcomes, and management. METHODS Following the Joanna Briggs Institute's scoping review recommendations, a comprehensive search in databases (EMBASE, MEDLINE, and gray literature) was conducted, with data independently extracted by two researchers from selected studies. RESULTS We analysed 24 articles involving 12,052 samples, predominantly published post-2000, 91% of which retrospective. The prevalence of culture-positive preservation fluid varied from 0.86 to 77.8%. Coagulase-negative staphylococci emerged as the most frequently isolated pathogen in 14 studies. The presence of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), observed in two studies involving 1074 donors, was significantly associated with an increased risk of probable donor-derived infections (p-DDI). Of the reviewed articles, 14 reported on probable donor-derived infections, while 19 addressed the topic of preemptive antibiotic therapy. CONCLUSIONS Routine culturing of preservation fluid is crucial for the identification of pathogenic organisms, facilitates targeted treatment and prevents probable donor-derived infections. Furthermore, this approach helps avoid the treatment of low-virulence contaminants, thereby reducing unnecessary antimicrobial use and the risk of antibiotic resistance. In cases where ESKAPE or Candida species are detected, preemptive therapy appears to be an important strategy. Given that the current evidence primarily stems from retrospective studies, there is a pressing need for large-scale, prospective trials to corroborate these recommendations. This scoping review currently represents the most thorough compilation of evidence on how contamination of preservation fluids affects kidney transplant management.
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Affiliation(s)
- Fabiani P Machado
- Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2.350 Largo Eduardo Zaccaro Faraco, Porto Alegre, RS, 90035-903, Brazil.
| | - Alessandra R Vicari
- Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2.350 Largo Eduardo Zaccaro Faraco, Porto Alegre, RS, 90035-903, Brazil
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Andrea C Bauer
- Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2.350 Largo Eduardo Zaccaro Faraco, Porto Alegre, RS, 90035-903, Brazil
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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2
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Boutin CA, Pouch SM, Ison MG. Utility of deceased donor cultures in solid organ transplantation in preventing donor-derived bacterial and fungal infectious diseases transmission. Transpl Infect Dis 2023; 25:e14032. [PMID: 36748658 DOI: 10.1111/tid.14032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor-derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by the risk of donor-derived infection (DDI) and the consequence of organ non-utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.
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Affiliation(s)
- Catherine-Audrey Boutin
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie M Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael G Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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3
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Schils R, Rampat R, Rakic JM, Crahay FX. Candida chorioretinitis in renal transplant recipient with candidemia related to contaminated organ preservation fluid: A role for dilated fundus examination in its management. IDCases 2023; 32:e01793. [PMID: 37207172 PMCID: PMC10188622 DOI: 10.1016/j.idcr.2023.e01793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/21/2023] Open
Abstract
Infection by Candida spp is a potentially life-threatening condition among both immunocompromised and immunocompetent patients. Candida chorioretinitis can occur as a complication of candidemia and may develop into endophthalmitis if not detected and treated early, which can lead to irreversible visual loss. Here, we report on a 52-year-old diabetic woman who developed candidemia complicated by bilateral chorioretinitis following kidney transplantation. Antifungal therapy was immediately started but fundoscopic examination highlighted multiple bilateral chorioretinal lesions. Given new onset of vomiting and increased number of retinal lesions on repeat fundus examination a few weeks later, the patient underwent a positron emission tomography (PET) which revealed a mycotic arterial pseudoaneurysm at the renal graft anastomosis. It led ineluctably to transplantectomy, aneurysm flattening and vascular reconstruction a few days later. Blood cultures remained negative and fundus examination progressively showed a regression of chorioretinal lesions until their complete disappearance a few months later. Our case emphasizes the importance of a non-invasive examination which allowed to accelerate and optimize in a consequential way the management of the patient leading to her recovery after a long antifungal treatment.
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Affiliation(s)
- Raphaël Schils
- Department of Internal Medicine and Infectious Diseases, University of Liege, Liege, Belgium
- Correspondence to: Avenue de l′hôpital 1, 4000, Liège, Belgium.
| | - Radhika Rampat
- Department of Ophtalmology, Queen Victoria Hospital NHS Foundation, East Grinstead, United Kingdom
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4
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Rinaldi M, Bonazzetti C, Gatti M, Caroccia N, Comai G, Ravaioli M, Morelli MC, Viale P, Giannella M. The impact of preservation fluid culture on graft site arteritis: A systematic review and meta-analysis. Transpl Infect Dis 2022; 24:e13979. [PMID: 36271646 PMCID: PMC10078333 DOI: 10.1111/tid.13979] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/23/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The role of culturing the graft preservation fluid (PF) is controversial and its impact on graft arteritis development remains unclear. METHODS Systematic literature search retrieving observational studies comparing solid organ transplant (SOT) recipients with culture-positive PF versus culture-negative PF. The quality of included studies was independently assessed according to the ROBINS-I tool for observational studies. Meta-analysis was performed using Mantel-Haenszel random-effect models. Graft site arteritis within 180 days from transplant was selected as the primary outcome. RESULTS Twenty-one observational studies (N = 2208 positive PF vs. 4458 negative) were included. Among positive PF, 857 (38.8%) were classified as high-risk group pathogens and 1351 (61.2%) as low-risk pathogens. Low-risk and negative PF showed similar odds ratios. A significant higher risk of graft arteritis was found in SOT recipients with a PF yielding a high-risk pathogen (odds ratio [OR] 18.43, 95% confidence interval [CI] 7.83-43.40) compared to low-risk and negative PF, with low heterogeneity (I2 = 2.24%). Similar results were found considering separately high-risk bacteria (OR 12.02, 95%CI 4.88-29.60) and fungi (OR 71.00, 95%CI 28.07-179.56), with no heterogeneity (I2 = 0%), and in the subgroup analyses of the liver (OR 16.78, 95%CI 2.95-95.47) and kidney (OR 19.90, 95%CI 4.78-82.79) recipients. However, data about diagnostic features of graft arteritis were very limited, indeed for only 11 of the 93 events histological or microbiological results were reported. CONCLUSIONS Our results may support the performance of PF culturing and a preemptive diagnostic or therapeutic management upon isolation of high-risk pathogens. Further studies based on a reliable diagnosis of graft arteritis are needed.
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Affiliation(s)
- Matteo Rinaldi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cecilia Bonazzetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Natascia Caroccia
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgia Comai
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Department of Hepatobiliary and Transplant Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum, University Hospital, Bologna, Italy
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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5
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Candida Contamination in Kidney and Liver Organ Preservation Solution: Does It Matter? J Clin Med 2021; 10:jcm10092022. [PMID: 34065096 PMCID: PMC8125956 DOI: 10.3390/jcm10092022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Fungal infections remain a major challenge affecting outcomes after kidney (KT) and liver transplantation (LT). METHODS In this retrospective single center study, the incidence of Candida contamination in renal and hepatic graft preservation solution (PS) was evaluated. In addition, Candida associated infections in recipients and related complications were analyzed. RESULTS Overall, the PS of 1248 hepatic and 1273 renal grafts were evaluated. The incidence of fungal contamination in the PS of hepatic and renal grafts was 1.2% and 0.86%, respectively. Additionally, the hepatic PS of one patient who underwent a combined liver-kidney transplant had Candida contamination. Candida albicans was the most common organism (70.4%) and 65.4% of the patients received antifungal treatment. Candida-associated complications in the recipients was 19%. Complications in LT patients included Candida peritonitis and Candida sepsis. Two KT recipients with contaminated PS developed a mycotic aneurysm at the anastomotic site resulting in severe bleeding. The 1-year mortality in patients with PS contamination for LT and KT recipients was 33% and 18%, respectively. Although the incidence of fungal contamination of PS was low, contaminated PS was associated with a high mortality. CONCLUSION The results of the study suggest that PS should be evaluated for fungal growth.
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6
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Flateau C, Aït-Ammar N, Angebault C, Salomon L, Matignon M, Lepeule R, Melica G, Grimbert P, Lelièvre JD, Gallien S, Botterel F. Risk factors for intra-abdominal fungal infection after simultaneous pancreas-kidney transplantation: A single-center retrospective experience. Transpl Infect Dis 2020; 23:e13486. [PMID: 33047447 DOI: 10.1111/tid.13486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/17/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Data on the risk factors and outcome of intra-abdominal fungal infections (IAFI) following simultaneous pancreas-kidney transplantation (PKT) are scarce. MATERIALS/METHODS A retrospective monocentric study was conducted on all patients who underwent simultaneous PKT from January 2007 to December 2016. Deep sites positive cultures for fungi during the first post-transplantation year were collected. Clinical, radiological, and microbiological data of proven and probable invasive fungal infections were analysed. RESULTS Among sixteen PKT patients, 15 were included. Seven patients (47%) developed an invasive fungal infection, exclusively IAFI (six proven, one probable). The proven IAFI included four peritonitis, one pancreatic necrosis with infected hematoma, and one patient with positive preservation fluid only (PF). Candida albicans (n = 4) was the most prevalent species (associated with Galactomyces candidus in one case), C glabrata, C dubliniensis, and C krusei were found in one case each. Three patients had either a positive direct examination and/or culture for renal or pancreatic PF and the culture of PF was positive for the same species that caused IAFI. IAFIs were significantly associated with pancreatic graft arterial thrombosis (5/7 vs 0/8, P = .007) and fungal contamination of PF (3/7 vs 0/8, P = .008). Among patients with IAFI, all required an early surgical revision post-transplantation [1-18 days] and six had early or delayed pancreatic graft removal. One patient died in the first post-transplant year. CONCLUSION IAFI is a common complication in PKT, associated with pancreatic graft thrombosis or fungal contamination of the graft PF, and can sometimes lead to pancreatic detransplantation.
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Affiliation(s)
- Clara Flateau
- Service de maladies infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France.,Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France
| | - Nawel Aït-Ammar
- Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Cécile Angebault
- Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Laurent Salomon
- Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'urologie, APHP, CHU Henri Mondor, Créteil, France
| | - Marie Matignon
- Service de néphrologie, APHP, CHU Henri Mondor, Créteil, France
| | - Raphaël Lepeule
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Unité Transversale du traitement des infections, Département Prévention, Diagnostic, DMU Biologie-Pathologie, APHP, CHU Henri Mondor, Créteil, France
| | - Giovanna Melica
- Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | | | - Jean-Daniel Lelièvre
- Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | - Sébastien Gallien
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | - Françoise Botterel
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
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7
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8
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Nagvekar V, Pranatharthi CH, Gopalakrishnan R, Anand R, Devarajan V, Thirunarayan M, Tarigopula A. Fatal aspergillosis of the renal vasculature in a combined liver-kidney transplant recipient. Indian J Med Microbiol 2018; 36:444-446. [PMID: 30429405 DOI: 10.4103/ijmm.ijmm_18_165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Invasive aspergillosis remains a problem in solid organs and haematopoietic stem cell transplants. We report a case of 12-year-old female with primary hyperoxaluria with regular haemodialysis for the end-stage renal disease. She underwent a combined liver and renal transplantation which got infected by aspergillosis. In this case study, it is speculated that the most likely source of Aspergillus was contaminated preservative solution (perfusate), resulting in infection within the donor kidney and subsequent systemic infection in the recipient. This case study calls for critical analysis and needs for the routine culture of the preservative solution before transplantation, to detect any fungal contamination and manage it prophylactically.
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Affiliation(s)
- Vasant Nagvekar
- Department of Infectious Diseases, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Ram Gopalakrishnan
- Institute of Infectious Diseases, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Ramamurthy Anand
- Department of Liver Transplant Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Vidya Devarajan
- Department of Infectious Diseases, Apollo Cancer Hospitals, Chennai, Tamil Nadu, India
| | | | - Anil Tarigopula
- Department of Molecular Diagnostics Laboratory and Transplantation Immunology, Apollo Hospitals, Chennai, Tamil Nadu, India
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9
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Pasternak Y, Rubin S, Bilavsky E, Mozer-Glassberg Y, Levy I, Nahum E, Rom E, Gurevich M, Ben-Zvi H, Ashkenazi-Hoffnung L. Risk factors for early invasive fungal infections in paediatric liver transplant recipients. Mycoses 2018; 61:639-645. [PMID: 29663565 DOI: 10.1111/myc.12784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022]
Abstract
Invasive fungal infections (IFIs) postliver transplantation are a frequent cause of morbidity and mortality; however, studies reporting on these infections in the paediatric population are scarce. To investigate the incidence and risk factors of IFIs in paediatric liver transplant recipients during the early posttransplantation period (≤3 months). Data were collected for all paediatric liver transplant recipients registered in a national transplantation center from 2004 to 2014. Using a stepwise logistic regression to identify independent risk factors for IFIs, a predictive model was formulated. Ten IFIs were identified in 81 liver transplant recipients (12.3%) all occurring during the first month posttransplantation. Candida species were responsible for nine cases (90%), of which four were non-albicans Candida (44%). Significant risk factors were identified; recipient of multiple blood product transfusions during transplantation, prolonged use of indwelling intravenous catheter, prolonged IV antibiotic treatment, surgical complications, pulse steroid treatment and living donor liver transplantation. The predictive model used two clinical parameters to define high-risk patients: a living donor transplantation and duration of IV antibiotic treatment (area under the ROC curve 0.918). IFIs are a significant complication occurring in the first month posttransplantation. Future studies are required to assess efficacy of targeted antifungal prophylaxis in high risk patients.
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Affiliation(s)
- Yehonatan Pasternak
- Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Shiri Rubin
- Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Efraim Bilavsky
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.,Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Yael Mozer-Glassberg
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.,Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Itzhak Levy
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.,Pediatric Infectious Diseases Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Elhanan Nahum
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.,Pediatric Intensive Care Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Eran Rom
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.,Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Michael Gurevich
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.,Liver Transplantion Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Haim Ben-Zvi
- Department of Clinical Microbiology, Rabin Medical Center, Petach Tikva, Israel
| | - Liat Ashkenazi-Hoffnung
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel.,Pediatric Infectious Diseases Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,Department of Pediatrics B, Schneider Children's Medical Center, Petach Tikva, Israel
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10
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Investigating Clinical Issues by Genotyping of Medically Important Fungi: Why and How? Clin Microbiol Rev 2017; 30:671-707. [PMID: 28490578 DOI: 10.1128/cmr.00043-16] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Genotyping studies of medically important fungi have addressed elucidation of outbreaks, nosocomial transmissions, infection routes, and genotype-phenotype correlations, of which secondary resistance has been most intensively investigated. Two methods have emerged because of their high discriminatory power and reproducibility: multilocus sequence typing (MLST) and microsatellite length polymorphism (MLP) using short tandem repeat (STR) markers. MLST relies on single-nucleotide polymorphisms within the coding regions of housekeeping genes. STR polymorphisms are based on the number of repeats of short DNA fragments, mostly outside coding regions, and thus are expected to be more polymorphic and more rapidly evolving than MLST markers. There is no consensus on a universal typing system. Either one or both of these approaches are now available for Candida spp., Aspergillus spp., Fusarium spp., Scedosporium spp., Cryptococcus neoformans, Pneumocystis jirovecii, and endemic mycoses. The choice of the method and the number of loci to be tested depend on the clinical question being addressed. Next-generation sequencing is becoming the most appropriate method for fungi with no MLP or MLST typing available. Whatever the molecular tool used, collection of clinical data (e.g., time of hospitalization and sharing of similar rooms) is mandatory for investigating outbreaks and nosocomial transmission.
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11
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Dupont D, Huguenin A, Tisserand E, Reiter V, Morelon E, Badet L, Villena I, Wallon M, Toubas D. Donor Derived Candida stellimalicola in a Clinical Specimen: Preservation Fluid Contamination During Pancreas Procurement. Mycopathologia 2017; 183:573-577. [PMID: 28681316 DOI: 10.1007/s11046-017-0171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/27/2017] [Indexed: 11/29/2022]
Abstract
We report here a case of possible donor-derived Candida stellimalicola infection after pancreas transplantation. Candida stellimalicola, an environmental non-filamentous yeast, was isolated from both the peritoneal fluid of the graft donor and the preservation fluid of the transplanted pancreas. Interestingly, this strain exhibited high minimum inhibitory concentrations to azoles. These results justified the use of echinocandins as therapy instead of fluconazole. This switch permitted a favorable outcome. To our knowledge, this is the first report of C. stellimalicola from clinical samples and therefore the first reported case of a possible human infection. This case report highlights the need for standardized microbiological procedures in solid organ transplant settings. Moreover, it underlines the importance of using molecular identification technique when routine techniques do not allow successful identification of the pathogen. It is of utmost importance to determine sensitivity profile, even in the absence of species-level identification, because resistance to fluconazole is not uncommon, especially in emergent species.
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Affiliation(s)
- Damien Dupont
- Institut des Agents Infectieux, Parasitologie Mycologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France. .,Integrative Physiology of the Brain Arousal Systems, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, 69000, France.
| | - Antoine Huguenin
- Laboratoire de Parasitologie Mycologie, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France
| | - Elodie Tisserand
- Pediatric Intensive Care Unit, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France
| | - Véronique Reiter
- PMO, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France
| | - Lionel Badet
- Service d'Urologie et Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France
| | - Isabelle Villena
- Laboratoire de Parasitologie Mycologie, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France.,Laboratoire de Parasitologie-Mycologie, EA3800, SFR Cap-Santé, UFR de Médecine, Université de Reims Champagne-Ardenne, Reims, 51100, France
| | - Martine Wallon
- Institut des Agents Infectieux, Parasitologie Mycologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France.,Integrative Physiology of the Brain Arousal Systems, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, 69000, France
| | - Dominique Toubas
- Laboratoire de Parasitologie Mycologie, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France.,MéDIAN-Biophotonique et Technologies pour la Santé, CNRS UMR 7369 MEDyC, UFR de Médecine, SFR CAP Santé, Université de Reims Champagne-Ardenne, Reims, 51100, France
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12
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Clinical Significance of Contamination of the Preservation Solution in Liver Transplantation. Transplant Proc 2016; 47:2322-3. [PMID: 26518916 DOI: 10.1016/j.transproceed.2015.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of the present study was to describe the incidence and microbiological profiles of positive cultures obtained from preservation solution (PS) and correlate these findings with infectious complications detected in the liver transplant (LT) recipient. PATIENTS We conducted a single-center, retrospective study between December 2010 and August 2014 among 178 LT. In all grafts, a PS culture was carried out. All the infections in the receipt until hospital discharge were collected. In patients with >1, infection was considered the most severe according to Clavien-Dindo classification. RESULTS PS culture was positive for bacterial or fungal agents in 79 of 178 LT recipients (44%). The most commonly cultured organisms were coagulase-negative staphylococci (64%), Enterobacteriaceae (17%), and Staphylococcus aureus (4.7%). In the 79 patients with positive PS, 49 blood cultures were requested in the period after LT. Twenty-five postoperative infections (31.7%) were diagnosed. Only 4 of 79 patients (5%) with PS contamination had a postoperative infections related with isolated microorganism. CONCLUSIONS Contamination of PS appears in a high percentage of liver grafts before LT, although there is a poor correlation with postoperative infections in LT recipient. In these patients, a standardized process including fungal and bacterial cultures could be useful.
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Levesque E, Paugam-Burtz C, Saliba F, Khoy-Ear L, Merle JC, Jung B, Stecken L, Ferrandiere M, Mihaila L, Botterel F. Fungal complications after Candida preservation fluid contamination in liver transplant recipients. Transpl Int 2015; 28:1308-16. [PMID: 26147662 DOI: 10.1111/tri.12633] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/07/2015] [Accepted: 06/18/2015] [Indexed: 12/14/2022]
Abstract
Donor-derived fungal infections can be associated with severe complications in transplant recipients. Donor-derived candidiasis has been described in kidney transplant recipients where contamination of the preservation fluid (PF) was a commonly proposed source. In liver transplantation, these fungal infections have been less explored. The aim of this study was therefore to determine the incidence and clinical relevance of Candida contamination of preservation fluid in the context of liver transplantation. A 5-year (2008-2012) retrospective multicentre study involving six French liver transplantation centers was performed to determine the incidence of Candida PF contamination. Postoperative clinical features, outcomes in recipients, and risk factors for Candida-related complications of liver transplantation were studied. Candida sp. was isolated from 28 of 2107 preservation fluid samples (1.33%). Candida albicans was the most common yeast (n = 18, 64%). Twenty-two recipients (78.5%) received antifungal therapy (echinocandins in 68%) for 7-37 days. Eight patients developed yeast-related complications (28.6%) including hepatic artery aneurysms (n = 6) and Candida peritonitis (n = 2). The 1-year mortality rate among patients after a yeast-related complication was 62.5%. The incidence of Candida PF contamination was low, but was associated with dramatic postoperative complications and high mortality. Close radiological follow-up may enable early recognition of the arterial complications associated with PF contamination by Candida.
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Affiliation(s)
- Eric Levesque
- Anesthesiology Department & Intensive Care - Liver ICU, AP-HP GH Henri Mondor, Créteil, France
| | - Catherine Paugam-Burtz
- Intensive Care & Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.,Sorbonne Paris Cité, Univ Paris Diderot, Paris, France.,INSERM U773, CRB3, Paris, France
| | - Faouzi Saliba
- Hepato-Biliairy Centre - Liver ICU, Hôpital Paul Brousse, Villejuif, France
| | - Linda Khoy-Ear
- Intensive Care & Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Jean-Claude Merle
- Anesthesiology Department & Intensive Care - Liver ICU, AP-HP GH Henri Mondor, Créteil, France
| | - Boris Jung
- Department of Critical Care Medicine and Anesthesiology, Saint Eloi Teaching Hospital, Montpellier, France.,INSERM U-1046, University Montpellier I, Montpellier II, Montpellier, France
| | - Laurent Stecken
- Intensive Care & Anesthesiology Department, CHU Bordeaux, Bordeaux, France
| | | | - Liliana Mihaila
- Microbiology Unit, G.H. Kremlin-Bicètre, Kremlin-Bicètre, France
| | - Francoise Botterel
- Mycology Unit - Microbiology Department, DHU VIC, EA Dynamyc UPEC-ENVA-GH Henri Mondor, Créteil, France
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Evans JDW, Morris PJ, Knight SR. Antifungal prophylaxis in liver transplantation: a systematic review and network meta-analysis. Am J Transplant 2014; 14:2765-76. [PMID: 25395336 DOI: 10.1111/ajt.12925] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/09/2014] [Accepted: 07/04/2014] [Indexed: 01/25/2023]
Abstract
Invasive fungal infections (IFIs) cause significant morbidity and mortality in liver transplant recipients, but the need and best agent for prophylaxis is uncertain. A comprehensive literature search was performed to identify randomized controlled trials comparing regimens for antifungal prophylaxis in liver transplant recipients. Direct comparisons were made between treatments using random-effects meta-analysis and a Bayesian network meta-analysis was performed for the primary end point of proven IFI. Fourteen studies met inclusion criteria, reporting comparisons of fluconazole, liposomal amphotericin B (L-AmB), itraconazole, micafungin and placebo. Overall, antifungal prophylaxis reduced the rate of proven IFI (odds ratio [OR] 0.37, confidence interval [CI] 0.19-0.72, p = 0.003), suspected or proven IFI (OR 0.40, CI 0.25-0.66, p = 0.0003) and mortality due to IFI (OR 0.32, CI 0.10-0.83, p = 0.02) when compared to placebo. All-cause mortality was not significantly affected. There was no difference in risk of adverse events requiring cessation of prophylaxis (OR 1.11, 95% CI 0.48-2.55, p = 0.81). In the network meta-analysis an equivalent reduction in the rate of IFI was seen with fluconazole (OR 0.21, CI 0.06-0.57) and L-AmB (OR 0.21, CI 0.05-0.71) compared with placebo. Routine prophylaxis with fluconazole or L-AmB reduces the incidence of IFI following liver transplantation, and the available evidence suggests that the two are equivalent in efficacy.
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Affiliation(s)
- J D W Evans
- Department of Medicine, Cambridge University, Cambridge, UK; Centre for Evidence in Transplantation, Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, London, UK
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Levesque E, Suet G, Merle J, Compagnon P, Amathieu R, Feray C, Botterel F, Foulet F, Azoulay D, Dhonneur G. Candidavascular complication in a liver transplant recipient due to yeast contamination of preservation solution. Transpl Infect Dis 2014; 16:827-9. [DOI: 10.1111/tid.12260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/13/2014] [Accepted: 04/09/2014] [Indexed: 01/01/2023]
Affiliation(s)
- E. Levesque
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
| | - G. Suet
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
| | - J.C. Merle
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
| | - P. Compagnon
- Service de Chirurgie Hépatique et digestive; GH Henri Mondor; Créteil France
| | - R. Amathieu
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
| | - C. Feray
- Service d'Hépatologie; GH Henri Mondor; Créteil France
| | - F. Botterel
- Unité de Parasitologie-Mycologie; Département de Microbiologie; DHU VIC; GH Henri Mondor; Créteil France
| | - F. Foulet
- Unité de Parasitologie-Mycologie; Département de Microbiologie; DHU VIC; GH Henri Mondor; Créteil France
| | - D. Azoulay
- Service de Chirurgie Hépatique et digestive; GH Henri Mondor; Créteil France
| | - G. Dhonneur
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
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Candida species contamination of preservation fluid-outcome of renal transplantation in 6 patients. Transplant Proc 2014; 45:2215-9. [PMID: 23953531 DOI: 10.1016/j.transproceed.2013.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/06/2013] [Accepted: 03/21/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND Fungal infections are a rare but important cause of morbidity and mortality in kidney transplantation. Fungal contamination of the kidney preservation fluid may, sometimes, be the cause of these infections. However, the clinical consequences of fungal contamination of this fluid are not completely understood and literature on this topic is controversial. The purpose of this study was to determine the incidence of preservation fluid contamination by fungi and its clinical consequences. METHODS From June 2010 to September 2011, a prospective cohort analysis was conducted at our center, enrolling all patients who received a renal allograft and whose perfusion fluid was analyzed for microbiology sterility. Patients with perfusion fluids positive for fungi were further studied: the patients' status was assessed during regular visits and data were recorded, including clinical characteristics, infections, graft function, immunosuppressive regimen and outcomes. RESULTS Microbiologic, cultures of 70 kidney perfusion fluids using specific mycologic media, obtained from 74 cadaveric renal transplants (4 fluids were unsuitable for analysis), were evaluated. Six samples were positive for yeasts (8.6%), with 4 isolates of Candida albicans and 2 isolates of Candida glabrata. Four patients had no evidence of fungal infection during the follow-up period (median 321 days); conversely, 2 patients developed severe mycotic vascular complications leading to transplantectomy. CONCLUSIONS Perfusion fluid contamination by fungi is an elusive situation that can lead either to an unremarkable clinical course or to graft loss life-threatening situations. Routine culture of kidney perfusion fluid is critical for prompt diagnosis and early implementation of appropriate treatment.
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Lladó L, Solé C, Bodro M, Baliellas C, Sabé N, Petit A, Ramos E, Carratalà J, Fabregat J. Candidaarteritis occurring in a liver transplant recipient. Transpl Infect Dis 2014; 16:465-8. [DOI: 10.1111/tid.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/18/2013] [Accepted: 12/18/2013] [Indexed: 01/16/2023]
Affiliation(s)
- L. Lladó
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - C. Solé
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - M. Bodro
- Infectious Diseases Department; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - C. Baliellas
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - N. Sabé
- Infectious Diseases Department; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - A. Petit
- Pathology Department; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - E. Ramos
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - J. Carratalà
- Infectious Diseases Department; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - J. Fabregat
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
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Yeast perfusion fluid contamination in pancreas transplantation. J Hosp Infect 2011; 78:68-9. [DOI: 10.1016/j.jhin.2011.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 01/19/2011] [Indexed: 01/16/2023]
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Chaim F, Boin I, Ataide E, Stucchi R. Perfusion Fluid Contamination in Relation to Recipient Survival and Acute Cellular Rejection in Orthotopic Liver Transplantation: Retrospective Analysis. Transplant Proc 2011; 43:1313-5. [DOI: 10.1016/j.transproceed.2011.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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